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The truth about testosterone therapy and when to consider treatment

As a hormone specialist, I see male patients all the time who want to be checked for low testosterone. It’s a smart move on their part.

Testosterone affects more than sex drive and erections. It plays a key role in energy, happiness, memory, mood, muscle strength and self-confidence for men. Some men with low testosterone levels say they feel they’ve “lost their edge.” One man told me that he used to love fishing, and now he didn’t feel like it at all.

It’s important to seek a solution for low testosterone. One option, however, has been vilified by the media over the past decade, and I want to help set the record straight.

Last month, the journal Mayo Clinic Proceedings released a review on testosterone therapy and cardiovascular risk, finally putting misconceptions about testosterone therapy to rest. A few poorly conducted, but well-publicized, studies suggested that testosterone therapy was unsafe and increased the risk of cardiovascular disease. But the overwhelming majority of scientific evidence shows that the exact opposite is true. Believe it or not, dozens of studies have shown that higher testosterone levels are associated with a decreased risk of cardiovascular disease, not the other way around.

Testosterone therapy has been correcting testosterone deficiency for more than 70 years. Deficiency was once blamed on certain cancers and disorders, but today we know that it’s common in many men and that there’s no known cause for it. Men naturally lose 1 to 2 percent or testosterone per year, and environmental stressors— such as endocrine-disrupting chemicals in everything from unfiltered water to plastic food containers— seem to be costing men their testosterone at alarmingly faster rates.

If you or the man you love has low testosterone and won’t try therapy, here are a few reasons to reconsider:

It can help lower your blood sugar and cholesterol.

Testosterone helps my patients lower their blood sugar and cholesterol, which surely reduces their risk of heart disease. New data have shown that testosterone therapy reduces blood sugar and hemoglobin a1c levels. In addition to these results, testosterone therapy can lead to men slimming down and getting leaner, as this study found, and it can improve their mood. This 2013 study published in the Journal of Clinical Endocrinology and Metabolism found that men with low testosterone who underwent testosterone therapy over a 60-day period saw an increase in energy, “good feelings” and friendliness, as well as a decrease in anger, nervousness and irritability.

Studies against it were flawed.

A few earlier (and flawed) studies unfortunately painted testosterone therapy with a broad and toxic brush.. One study reversed raw data, another published symptoms that had never been tracked prior to the study, and a third literally sought out and reported studies with patients who experienced adverse cardiovascular events.

Don’t mistake media hype for a sound medical decision.

This happened with estrogen therapy, too. In 2002, a study was released that claimed taking estrogen hormone replacement therapy was an immense risk to women’s health. As a result, estrogen therapy was stigmatized in the media for years. Almost a decade later, it was reported in this study that rejecting estrogen hormones had caused the early deaths of nearly 50,000 women. Let that number sink in for a moment. The last thing any of us want is for men to experience the same thing.

This is not to say that testosterone therapy is the right choice for everyone, but it’s worth considering— particularly in conjunction with a physician who specializes in hormones and hormone therapy. These experts will know what signs to look for to determine if you should begin prescription testosterone therapy, and they will know what side effects to look for while monitoring you.

I am grateful to the authors of the Mayo Clinic Proceedings review for addressing such an important topic that has a huge impact on men’s health. All doctors who take care of men should read the review and understand the important role that testosterone therapy can serve in a man’s life.